Is it normal to have some symptoms after the gastric sleeve operation?

It is entirely expected that after any major surgery, such as the gastric sleeve, there will be discomfort, signs, and related symptoms.

Learn what these symptoms are, why they occur, and how to manage them.

Why do these symptoms occur?

Sometimes the fact that the surgery is performed by laparoscopy or minimally invasive can cause some patients to interpret that it is something very simple when the truth is that the gastric sleeve is considered major surgery.

Thanks to the laparoscopic technique, new surgical knowledge, and accelerated patient recovery, things are very different now than a few decades ago. Just 30 years ago, the patient was left to fast completely for more than 24-48 hours, a nasogastric tube was placed, and they remained hospitalized for at least 3 or 4 days after gastric surgery.

We mention this to give you a better perspective of the magnitude of the procedure involved in a gastric sleeve or gastric bypass and that the small incisions you see in the abdomen are just that: small incisions.

Most common symptoms after gastric sleeve surgery

Signs and symptoms after gastric sleeve surgery are variable. Below we list the most common ones according to the moment in which they appear during the patient's recovery process.

Immediate phase after gastric sleeve surgery (first 12 to 36 hours)

1.- Pain after gastric sleeve surgery

The pain perceived in most cases is a pain that many patients do not even classify as such but rather as mild discomfort. Many describe it as discomfort experienced when doing many abdominal crunches the day before.

Some patients (every patient is different, and you shouldn't compare to anyone) experience more noticeable pain, but they are a minority. In almost all of these cases, the pain is entirely controllable with the intravenous medications we administer in the first 12 postoperative hours.

After this time, they usually no longer require pain medication, much less a narcotic type.

2.- Nausea and/or vomiting after gastric sleeve

This is another widespread concern in patients, and it is something natural since nausea is a very unpleasant symptom.

Nausea does become more frequent and intense than pain, but with the medications that we usually administer to our patients, this nausea can be totally or partially controlled in most cases.

Some patients may vomit, but the effort of involuntary abdominal contraction when vomiting does not pose any risk to your surgery (it is a common question from our patients). In these cases, if any stomach contents come out, it is almost a fact that it will be stained with blood. Still, it is completely normal and expected, so you should not worry about this symptom if it occurs in your case.

3.- Dizziness or vertigo after gastric sleeve surgery

This symptom appears like the previous two in the first hours after surgery. It is common for it to appear after so many hours lying down (not during surgery, as it only lasts approximately 45 minutes), but during the hours when the patient is recovering from the procedure, and his/her body is eliminating the medications used during the anesthesia. This symptom usually occurs the first two or three times the patient gets out of bed.

What I recommend to my patients is that when they decide to start walking (which should be soon after they wake up and feel good) is that they anticipate and raise the back of the bed and stay that way for 5 to 10 minutes to later sit on the edge of the bed and remain like that for the same period of time.

Once these first two steps have elapsed, get up slowly and preferably with the support of your family member or one of our nurses. If they feel ready, they can start walking; if not, they should lie down again and try again later. It is important to start walking after surgery but not at the cost of causing a fall or severe nausea that would delay recovery rather than speed it up.

4.- Sensation of oppression in the chest after the gastric sleeve

Pain or a feeling of pressure in the lower chest or upper abdomen is a prevalent symptom, more than the previous ones.

This happens because of the drastic change in the size of the stomach. Because if before the surgery a low or moderate amount of saliva, gastric juices and/or air did not even cause any discomfort, a person after gastric sleeve surgery feels it as an exaggerated amount of these contents inside their stomach.

This is why patients commonly tell us that they feel like they want to burp but can't, and the point is that it's so tiny that nothing comes out. Besides what we give them intravenously, the best medicine for this is time and walking to be as active as possible and pass those contents.

5.- Pain in the back or shoulder(s)

This discomfort is not so common, but when it occurs, it causes concern in the patient since it occurs in a place far from the surgery and seems strange to them.

This happens because the carbon dioxide we introduce into the abdominal cavity to perform laparoscopic surgery usually goes to the upper part of the abdomen and causes this discomfort in one or both shoulders.

Another explanation for this symptom that makes it appear more frequently is that during surgery if we find the presence of a hiatal hernia, which we repair in 100% of cases, this repair causes these discomforts more frequently than the aforementioned CO2 explanation.

6.- Dry mouth sensation

This symptom is common and somewhat uncomfortable, but it disappears in a matter of hours once the medication wears off and the patient can drink fluids (water) in the form of ice.

While it is happening, the patient can use water, brush their teeth and use Biotene or some other mouthwash to moisten their mouth.

7.- Hiccups after gastric sleeve surgery

Hiccups are an extremely common sign in male patients.

We do not know the cause, but probably 5 out of 10 male patients that we operate on have hiccups to a greater or lesser extent, a sign that usually disappears the same day or the day after surgery.

As with vomiting, this involuntary reflex does not cause any problems in surgery, but it is tedious for the patient.

8.- Headache after gastric sleeve surgery

Headache is more common than expected. Several factors can trigger headaches after gastric sleeve surgery.

The first is the physical and emotional stress to which the patient has been subjected. No matter how calm you were at the time of surgery, stress hormones are still released, even before the procedure.

In addition, the patient is asked to fast for at least 8 hours. In my practice, I do not usually start the oral intake in the first hours of the postoperative period. We manage hydration and "nutrition" through the vein using serums with glucose, which is usually not enough considering that the patient's body is used to high amounts of carbohydrates, especially if you did not had follow a preoperative diet.

Therefore, their low or no intake in the first hours of the postoperative period causes a headache, which is difficult to remove completely. However, it is only a matter of hours before it improves and disappears.

Lastly, many patients are used to drinking coffee, and its sudden removal can also cause headaches.

Signs or symptoms in the mediate period (1 week to 3 months after surgery)

9.- Reflux months after the gastric sleeve

As you surely know, if there is any negative aspect of gastric sleeve surgery, it is the presence of reflux.

The good news is that when it comes to a well-selected patient by their bariatric surgeon in whom esophagitis and severe reflux are ruled out before surgery, it is almost a given that a few months after the procedure (estimated between 4 and 7 months), the reflux will have disappeared entirely or will at least be at the levels of intensity before surgery. During the first months, you must be patient and take the medications that your bariatric surgeon recommends.

10.- Náusea months after vertical sleeve gastrectomy

If nausea continues to be a predominant symptom, we advise paying close attention to details such as:

  • The medications you are taking.
  • The speed at which you are taking or eating your food.
  • If you are correctly chewing each bite.
  • The amount of food you are eating per feed.
  • The presence or absence of gastritis and/or reflux.

Numerous factors could be causing nausea after months of gastric sleeve surgery that are generally resolved with modifications to one or more of the details mentioned above.

If it is not just nausea but vomiting that does not allow you to maintain adequate/sufficient hydration or nutrition, contact your bariatric group for support.

11.- Pain in the incisions

It is very likely that after a couple of weeks of surgery, you will no longer have pain in the incisions, or it will be minimal. After a month of surgery, you can do all the physical activities you want.

12.- Fatigue, lack of energy after weight loss surgery

This common symptom occurs only during the first ten days after surgery. Afterward, this weakness usually reverses completely to a sense of vigor and energy that patients describe as not having felt in years!

This sensation is very often the reason why elderly patients regret not having had surgery before since they can return to activities that they had not done for a long time.

13.- Constipation

Intestinal constipation after gastric sleeve surgery is common. It must be taken into consideration that at least during the first two or three weeks after surgery, it is difficult for the patient to have bowel movements as they usually did since, due to the liquid-based diet, the amount of fecal stool that can be formed is considerably smaller.

If, after the initial phases of a postoperative diet LINK A ARTÍCULO PORFA, the bowel habit does not return or is close to normal for each patient before surgery, the intake of a mild laxative should be considered, in addition to making sure to ingest a sufficient amount of fluids. The best thing you can do is rely on your bariatric surgeon to guide you properly.

Signs or symptoms in the medium to the long-term period (4 months to 18 months)

14.- Reflux

As previously mentioned, this problem should be resolved within 6 to 8 months after surgery, once the weight loss is such that the triggers for reflux are no longer present.

15.- Hair loss after gastric sleeve

This situation worries both men and women when undergoing gastric sleeve surgery, and rightly so since it is a problem that usually occurs in many cases.

However, the good news is that it is a temporary situation that occurs between the 3rd and 6th month after surgery and resolves progressively as the months progress, reaching normality in most cases.

All this is considering that the patient is following the medical indications and is ingesting their multivitamins, supplements, and protein with adequate frequency and doses. If they do not do things as indicated, this hair loss will likely continue or not recover as expected.

16.- Rhinorrhea (runny nose)

This is an infrequent sign, but we mention it because of its peculiarity since some patients present a slightly runny nose when they start eating their food.

There is no clear explanation in this regard. Still, it is usually temporary and of mild intensity that does not affect the patient's life. In addition, some patients may present occasional sneezing after gastric sleeve surgery when eating.

17.- Dysgeusia

After gastric sleeve surgery, there may be alterations in the perception of the flavor of certain foods. However, it is not a concern since it is usually a different but not unpleasant perception of the taste of a specific food or a group of foods.

The most common being that said group is carbohydrates, which may or may not please the patient but definitely plays in favor of the patient's objective. These patients often see it as an advantage rather than a problem.

18.- Intolerance to certain foods

Very similar to what was mentioned with dysgeusia after obesity surgery, there are cases where patients feel that they cannot eat a specific type of food, which is usually flour. However, sometimes it happens with legumes, fibrous vegetables (lettuce, celery, spinach, etc.) or red meat.

This is in a tiny percentage of cases and is usually something temporary. In this case, all you have to do is replace said foods with others while this sensation that they do not "go along" with the stomach disappears.

19.- Dumping syndrome

This well-known syndrome tends to occur much more frequently in mixed or malabsorptive procedures such as a duodenal switch or gastric bypass.

However, certain gastric sleeve patients suffer from the accompanying signs and symptoms of this syndrome, so there is nothing more to do than avoid foods that cause it, such as processed carbohydrates and refined sugars, or at least reduce the quantity and speed at which they are ingested.

The best recommendation is to avoid them and take advantage of this "problem" that, in the long run, would be a factor in favor of the objective for which the person is undergoing weight loss surgery.

If you have questions or comments, do not hesitate to contact us!